Episode 16: September 30, 2009
by Rob Lamberts, MD
This is part two of a series on primary care. In my previous podcast I discussed what primary care is, and why it is important. Assuming I convinced you, I’ll now give advice on how to find a good primary care doctor.
What is Primary Care?
Primary care is different from most other specialties in that it focuses on relationship. The best care is given when the doctor and patient know each other well. In that situation, the doctor knows the patient well enough to make informed decisions about care, and the patient feels comfortable asking questions and knows how to interpret answers. Personally, I don’t care if the guy taking out my appendix has a good bedside manner-- I just want him to be a good surgeon; but I need to be able to communicate well with the person helping me manage my diabetes or keeping my kids healthy.
Find the Best Doctor for You
But as you certainly know, long-term relationships can be hard. Just like dating, it is very important to find the physician who gives you what you are looking for. And just like dating, primary care physicians vary widely in personality and practice style. You want to find the best match between you and your doctor, but that isn’t always easy.
It would be nice if there was find your dream doctor dot com that worked a lot like the matchmaking sites you see advertised all over the place. But despite the fact that there isn’t such a website, you can use some of their principles to narrow down your search. You do this by listing what you are looking for in a doctor. What are the negotiables and non-negotiables?
How to Decide What Kind of Doctor You Want
Here’s a list of some important things to consider:
Do you want a younger doctor with recent training, or an older doctor with experience?
Does it matter more if your doctor is on time and efficient, or would you rather have one who takes time to talk but frequently runs late?
Do you want a well-established popular doctor with fewer appointments available, or a less-known one with more openings?
Some doctors are organized and obsessive, while others are laid-back and intuitive
What about a doctor who sets the rules and tells you what to do, versus one who negotiates and explains?
And finally, would you rather have a more specialized doctor, like a pediatrician or internal medicine doctor, versus one who can see the whole family?
Different people have different preferences in these areas. The most important thing for some people is that their doctor is always on time; people will often compromise on the other things to ensure they don’t have to spend a long time in the waiting room. To others, the doctor you sit back and chat with is worth the wait. I have seen some colleagues who would routinely run 2-3 hours late, but patients are lining up to see them. There is a reason people were willing to wait.
What Should You Look for in a Doctor?
Now, there are a few things I think are non-negotiables when looking for a PCP. I recommend you pay attention to the following things:
1. Accessibility: You have to be able to get help when you need it. If a doctor’s phones are always busy, or if you can’t get your child seen when they have a fever of 104, then I would look elsewhere. That doesn’t mean that you should be able to get the doctor whenever you want. During the day a doctor is busy seeing patients in the office, and taking lots of time on the phone takes away from the care of the people paying to be seen. Don’t have unrealistic expectations, but you absolutely should easily be able to get your questions adequately answered in an appropriate amount of time.
2. Record Keeping: When you do go in to see a doctor, pay attention to how they keep their records. If a doctor does not take careful notes, you should be wary. There is no way to keep track of everything without good record keeping. Poor record keeping is a sign of sloppiness and inattention to detail. That is a big red flag in my book.
3. Customer Service: A consistently rude or apathetic-sounding staff is a bad sign. I believe that my staff will treat my patients only as well as I treat my staff, so if the staff treats you poorly, chances are good that they are treated poorly. Besides, you will have to go through the office staff when you want to contact your doctor. You don’t want that process to be painful.
4. Putting the patient before the business: It is real a temptation for doctors to order more tests if there is strong financial gain from doing so. All of us physicians have to find the balance. Look out for doctors who order lots of in-office tests every time you come to be seen. There may be a good explanation, but if you do begin to suspect this problem, ask your doctor the following: “What are you hoping to learn from this test?” It should be easy to answer this if the test was appropriate. If you don’t get a straight answer, beware.
5. No over-prescribing of narcotics: Doctors are bombarded with requests for addictive medications like Xanax and Percocet. It is our responsibility to only give medications that are necessary. Over–prescribing these dangerous drugs may mean they are people pleasers, with their desire to make every patient happy making them careless. This may seem innocent, but doctors can’t please everyone. You don’t want a doctor who won’t give you bad news or stand up to unreasonable demands of patients. You want the person in charge of your health to be strong.
How to Find a Good Primary Care Doctor
So where do you go to find “Doctor Right?” Here are my quick and dirty tips on finding a good primary care physician:
Tip 1: Ask Around
The people who know the doctor the best are the patients. Ask people for advice; and when they tell you, ask them why they like this doctor. Don’t rely on one source if at all possible, as people can misjudge the quality of their care. I have heard it said that even the worst doctors have patients who think they are good.
Tip 2: Check out the Website
You can glean lots of good information by seeing what foot doctors put forward on the Web. Do they explain things-- like billing policies-- well? Is there personal information about the doctor? Are there forms you can fill out posted on the site?
Tip 3: Call the Office
How the office handles you as a new patient inquiring about the doctor will tell you much about the care you will get. Are they organized and efficient? Do you wait on hold for a long time? Please note that if you call on a Monday morning, you will probably wait for any office. PCP offices are usually flooded at that time.
Tip 4: Visit the Office
Pick up your paperwork in person and take note of what you see. Is the staff courteous? Do they seem happy? Is the waiting area clean and inviting, or is it disorganized and dingy? These shouldn’t be deal breakers, but they do give you hints.
Tip 5: Ask Another Doctor
If you do know a doctor personally, ask them whom they’d recommend. It is much easier for me to spot good and bad doctors than it is for non-medical people. Ideally, you want to go to a doctor that other doctors use as their PCP.
Tip 6: Be Willing to Walk Away
There are no vows that are spoken when you pick a PCP. You won’t be censured by the Vatican or have to go to court if you change your mind. If you do your due-diligence and end up being dissatisfied, change your doctor. The most important thing between you and your PCP is trust. Don’t worry about hurting the doctor’s feelings if you leave. As a physician, I don’t want patients who don’t trust me-- it’s a bad arrangement for both parties.
I hope that gives you something to work with in choosing your PCP.
If you have questions you want answered, send them to firstname.lastname@example.org. You can find me on Twitter as @housecalldoc and on Facebook under “House Call Doctor.”
Please don’t forget that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Catch you next time! Stay Healthy!